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Clinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET/COSS era

  • Clinical Article - Vascular
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Abstract

Background

Even after the recent randomized clinical trials JET and COSS, it is still unclear that impaired cerebrovascular reactivity (CVR) to acetazolamide and oxygen extraction fraction (OEF) can identify the candidates for superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. This prospective study was aimed to evaluate the benefits of STA-MCA “double” anastomosis on long-term outcome in patients with reduced cerebral blood flow (CBF) and CVR (Type 3 ischemia) and elevated OEF attributable to occlusive carotid diseases.

Methods

This study included 49 patients with reduced CBF and CVR on SPECT in the ipsilateral MCA area. Using 15O-gas PET, OEF was also measured in all patients. STA-MCA double anastomosis was recommended to the patients with Type 3 and elevated OEF. Those with Type 3 but normal OEF were medically treated.

Results

Of 36 patients with Type 3 and elevated OEF, 25 consented to surgery. No perioperative morbidity or mortality were noted. The other 11 patients with Type 3 and elevated OEF were medically treated. Annual incidence of ipsilateral stroke was 0.7 % and 6.5 % in surgically and medically treated patients with Type 3 and elevated OEF, respectively (P = 0.0188). None of patients with Type 3 but normal OEF developed ipsilateral stroke during follow-up periods. STA-MCA “double” anastomosis significantly decreased OEF.

Conclusions

STA-MCA “double” anastomosis may still have the potential to reduce the risk of recurrent ipsilateral stroke in hemodynamically compromised patients. Further studies would be essential to advance diagnosis, surgical procedures, and perioperative managements to bring out maximal effects of bypass surgery.

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Authors and Affiliations

  1. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Satoshi Kuroda, Masahito Kawabori, Daina Kashiwazaki & Kiyohiro Houkin

  2. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Kenji Hirata, Tohru Shiga & Nagara Tamaki

  3. Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Sugitani 2630, Toyama, 930-0194, Japan

    Satoshi Kuroda

Authors
  1. Satoshi Kuroda
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  2. Masahito Kawabori
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  3. Kenji Hirata
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  4. Tohru Shiga
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  5. Daina Kashiwazaki
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  6. Kiyohiro Houkin
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  7. Nagara Tamaki
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Correspondence to Satoshi Kuroda.

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Kuroda, S., Kawabori, M., Hirata, K. et al. Clinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET/COSS era. Acta Neurochir 156, 77–83 (2014). https://doi.org/10.1007/s00701-013-1961-0

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  • DOI: https://doi.org/10.1007/s00701-013-1961-0

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